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Macular Pucker
Other Names:
Epiretinal membrane, pre-retinal membrane,
cellophane maculopathy,
retina wrinkle, surface
wrinkling retinopathy, pre-macular fibrosis, and
internal limiting membrane disease.
What is a macular pucker?
A
macular pucker is
scar tissue that has formed on the eye's
macula,
located in the center of the eye's light-sensitive
tissue called the retina. The macula provides the
sharp, central vision we need for reading, driving,
and seeing fine detail. A macular pucker can cause
blurred and distorted central vision.
Most of the eye's interior is filled with
vitreous, a gel-like substance that fills about 80
percent of the eye and helps it maintain a round
shape. The vitreous contains millions of fine fibers
that are attached to the surface of the retina. As
we age, the vitreous slowly shrinks and pulls away
from the retinal surface. This is called a vitreous
detachment, and is normal. In most cases, there are
no adverse effects, except for a small increase in
floaters, which are little "cobwebs" or specks that
seem to float about in your field of vision.
However, sometimes when the vitreous pulls away
from the
retina, there is microscopic damage to the
retina's surface (Note: This is not a
macular hole).
When this happens, the retina begins a healing
process to the damaged area and forms scar tissue,
or an epi-retinal membrane, on the surface of the
retina. This scar tissue is firmly attached to the
retina surface. When the scar tissue contracts, it
causes the retina to wrinkle, or pucker, usually
without any effect on central vision. However, if
the scar tissue has formed over the
macula, our
sharp, central vision becomes blurred and distorted.
What causes a macular pucker?
Most macular puckers are related to vitreous
detachment, which usually occurs in people over age
50. As you age, you are at increased risk for
macular pucker.
A macular pucker can also be triggered by certain
eye diseases and disorders, such as a detached
retina and inflammation of the eye (uveitis). Also,
people with diabetes sometimes develop an eye
disease called
diabetic retinopathy, which can cause
a macular pucker. A macular pucker can also be
caused by trauma from either surgery or an eye
injury.
Vision loss from a macular pucker can vary from
no loss to severe loss, although severe vision loss
is uncommon. People with a macular pucker may notice
that their vision is blurry or mildly distorted, and
straight lines can appear wavy. They may have
difficulty in seeing fine detail and reading small
print. There may be a gray area in the center of
your vision, or perhaps even a
blind spot.
Is a macular pucker the same as age-related
macular degeneration?
No. A macular pucker and
age-related macular
degeneration are two separate and distinct
conditions, although the symptoms for each are
similar. An eye care professional will know the
difference.
Can macular pucker get worse?
For most people,
visual acuity remains stable and does
not get progressively worse. Usually macular pucker
affects one eye, although it may affect the other
eye later.
Is a macular pucker similar to a macular hole?
A macular pucker and a
macular hole are different
conditions, although they both result from the same
reason: The pulling on the
retina from a shrinking
vitreous. When the "pulling" causes microscopic
damage, the retina can heal itself; scar tissue, or
a macular pucker, can be the result. If the
shrinking vitreous pulls too hard, it can tear the
retina, creating a macular hole, which is more
serious. Both conditions have similar symptoms -
distorted and blurred vision. Also, a macular pucker
will not "develop" into a macular hole. An eye care
professional will know the difference.
Macular pucker surgery?
A macular pucker usually requires no treatment.
In many cases, the symptoms of vision distortion and
blurriness are mild, and no treatment is necessary.
People usually adjust to the mild visual distortion,
since it does not affect activities of daily life,
such as reading and driving.
Eye drops, medications,
nor nutritional supplements will improve vision
distorted from macular pucker. Sometimes the scar
tissue--which causes a macular pucker--separates
from the retina, and the macular pucker clears up.
Rarely, vision deteriorates to the point where it
affects daily routine activities. However, when this
happens, surgery may be recommended. This procedure
is called a
vitrectomy, in which the
vitreous gel is
removed to prevent it from pulling on the retina and
replaced with a salt solution (Because the vitreous
is mostly water, you will notice no change between
the salt solution and the normal vitreous). Also,
the scar tissue which causes the wrinkling is
removed. A vitrectomy is usually performed under
local anesthesia.
After the operation, you will need to use medicated eye drops to
protect against infection.
How successful is this surgery?
Surgery to repair a macular pucker is very
delicate, and while vision improves in most cases,
it does not usually return to normal. On average,
about half of the vision lost from a macular pucker
is restored; some people have significantly more
vision restored, some less. In most cases, vision
distortion is significantly reduced. Recovery of
vision can take up to three months. Patients should
talk with their eye care professional about whether
treatment is appropriate.
What are the risks of surgery?
The most common complication of a vitrectomy is
an increase in the rate of
cataract development.
Cataract surgery may be needed within a few years
after the vitrectomy. Other, less common
complications are
retinal detachment either during
or after surgery, and infection after surgery. Also,
the macular pucker may grow back, but this is rare.
Research
Research studies are being conducted to determine
other treatments for macular pucker. Please note
that both of the procedures described below need
additional clinical testing. We suggest you share
this information with your eye care professional.
Some physicians are researching the use of a
surgical procedure in which scar tissue is peeled
off without performing the vitrectomy.
Other doctors are researching a new surgical
technique to remove the internal limiting membrane
(a layer of the
retina) for patients with both
macular pucker and macular hole. This surgical
technique is called Fluidic Internal Limiting
Membrane Separation (FILMS). After a vitrectomy,
fluid is injected between the membrane and the
retina that causes the membrane, along with the scar
tissue, to lift away. It is then removed with
forceps.
Resources
The following organizations may be able to
provide additional information on macular pucker:
National Eye Institute
2020 Vision Place
Bethesda, MD 20892-3655
(301) 496-5248
http://www.nei.nih.gov/
American Academy of Ophthalmology
P.O. Box 7424
San Francisco, CA 94120-7424
(415) 561-8500
Distributes a fact sheet on macular pucker for
patients.
For additional information, you may wish to
contact a local library.
Courtesy of the National Eye Institute |
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